Anesthetic Implications of Pituitary Stalk Interruption Syndrome in a Child Undergoing Nonneurological Surgery

Abstract

Pituitary stalk interruption syndrome (PSIS) is a rare congenital hypothalamic–pituitary disorder characterized by progressive anterior pituitary hormone deficiencies. Its anesthetic significance lies in the potential for unrecognized metabolic and hemodynamic instability. We report the anesthetic management of a 9-year-old boy with PSIS, growth hormone deficiency, and secondary hypothyroidism undergoing laparoscopic elective orchidopexy. Magnetic resonance imaging confirmed PSIS, and adrenocorticotropic hormone stimulation testing demonstrated intact adrenal reserve, permitting omission of empirical perioperative steroids. Preoperative endocrine optimization, vigilant glucose monitoring, judicious anesthetic dosing, and temperature regulation resulted in an uneventful perioperative course. This case highlights the importance of individualized endocrine risk stratification in children with PSIS presenting for nonneurosurgical procedures.